Karanikolos Marina, Gordeev Vladimir S, Mackenbach Johan P, McKee Martin
European Observatory on Health Systems and Policies, London, UK The Centre for Health and Social Change (ECOHOST), London School of Hygiene and Tropical Medicine, London, UK
Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, The Netherlands.
Eur J Public Health. 2016 Apr;26(2):236-41. doi: 10.1093/eurpub/ckv205. Epub 2015 Nov 4.
In 2009, brief but deep economic crisis profoundly affected the three Baltic States: Estonia, Latvia and Lithuania. In response, all three countries adopted severe austerity measures with the shared goal of containing rising deficits, but employing different methods.
In this article, we analyze the impact of the economic crisis and post-crisis austerity measures on health systems and access to medical services in the three countries.
We use the EU-SILC data to analyze trends in unmet medical need in 2005-2012, and apply log-binomial regression to calculate the risk of unmet medical need in the pre- and post- crisis period.
Between 2009 and 2012 unmet need has increased significantly in Latvia (OR: 1.24, 95% confidence interval (CI): 1.15-1.34) and Estonia (OR: 1.98, 95% CI: 1.72-2.27), but not Lithuania (OR: 0.84. 95% CI: 0.69-1.04). The main drivers of increased unmet need were inability to afford care in Latvia and long waiting lists in Estonia.
The impact of the crisis on access to care in the three countries varied, as did the austerity measures affecting their health systems. Estonia and Latvia experienced worsening access to care, largely exacerbating already existing barriers. The example of Lithuania suggests that deterioration in access is not inevitable, once health policies prioritise maintenance and availability of existing services, or if there is room for reducing existing inefficiencies. Moreover, better financial preparedness of health systems in Estonia and Lithuania achieved some protection of the population from increasing unmet need due to the rising cost of medical care.
2009年，短暂但严重的经济危机对波罗的海三国——爱沙尼亚、拉脱维亚和立陶宛产生了深刻影响。作为应对措施，这三个国家都采取了严厉的紧缩措施，目标都是控制不断上升的赤字，但采用的方法各不相同。
在本文中，我们分析了经济危机和危机后紧缩措施对这三个国家卫生系统和医疗服务可及性的影响。
我们使用欧盟收入和生活条件调查（EU-SILC）数据来分析2005 - 2012年未满足医疗需求的趋势，并应用对数二项回归来计算危机前和危机后未满足医疗需求的风险。
2009年至2012年期间，拉脱维亚（比值比：1.24，95%置信区间（CI）：1.15 - 1.34）和爱沙尼亚（比值比：1.98，95% CI：1.72 - 2.27）的未满足需求显著增加，但立陶宛没有（比值比：0.84，95% CI：0.69 - 1.04）。未满足需求增加的主要驱动因素在拉脱维亚是无力支付医疗费用，在爱沙尼亚是漫长的等候名单。
危机对这三个国家医疗服务可及性的影响各不相同，影响其卫生系统的紧缩措施也是如此。爱沙尼亚和拉脱维亚的医疗服务可及性恶化，在很大程度上加剧了已有的障碍。立陶宛的例子表明，一旦卫生政策优先考虑维持和提供现有服务，或者如果有降低现有低效率的空间，医疗服务可及性的恶化并非不可避免。此外，爱沙尼亚和立陶宛卫生系统更好的财务准备在一定程度上保护了民众，使其不因医疗费用上涨导致未满足需求增加。
